Published online Dec 27, 2021. doi: 10.4240/wjgs.v13.i12.1754
Peer-review started: April 28, 2021
First decision: June 17, 2021
Revised: June 9, 2021
Accepted: November 15, 2021
Article in press: November 15, 2021
Published online: December 27, 2021
Three-dimensional (3D) modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models, which more closely resemble the complex environment encountered during surgery. It has been successfully applied to surgical planning and navigation, as well as surgical training and patient education in several surgical specialties, but its uptake lags behind in colorectal surgery. Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis, which is difficult to comprehend and visualise.
To review the current and emerging applications of the 3D models, both virtual and physical, in rectal cancer surgery.
Medline/PubMed, Embase and Scopus databases were searched using the keywords “rectal surgery”, “colorectal surgery”, “three-dimensional”, “3D”, “modelling”, “3D printing”, “surgical planning”, “surgical navigation”, “surgical education”, “patient education” to identify the eligible full-text studies published in English between 2001 and 2020. Reference list from each article was manually reviewed to identify additional relevant papers. The conference abstracts, animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded. Data were extracted from the retrieved manuscripts and summarised in a descriptive way. The manuscript was prepared and revised in accordance with PRISMA 2009 checklist.
Sixteen studies, including 9 feasibility studies, were included in the systematic review. The studies were classified into four categories: feasibility of the use of 3D modelling technology in rectal cancer surgery, preoperative planning and intraoperative navigation, surgical education and surgical device design. Thirteen studies used virtual models, one 3D printed model and 2 both types of models. The construction of virtual and physical models depicting the normal pelvic anatomy and rectal cancer, was shown to be feasible. Within the clinical context, 3D models were used to identify vascular anomalies, for surgical planning and navigation in lateral pelvic wall lymph node dissection and in management of recurrent rectal cancer. Both physical and virtual 3D models were found to be valuable in surgical education, with a preference for 3D printed models. The main limitations of the current technology identified in the studies were related to the restrictions of the segmentation process and the lack of 3D printing materials that could mimic the soft and deformable tissues.
3D modelling technology has potential to be utilised in multiple aspects of rectal cancer surgery, however, it is still at the experimental stage of application in this setting.
Core Tip: Three-dimensional (3D) modelling technology has revolutionized preoperative planning, intraoperative navigation, and surgical training in several surgical specialties. Rectal cancer surgery poses significant challenges due to the complex anatomy of the pelvis. While there is marked interest in the application of 3D modelling in this field, it appears to be still in its relative infancy. Future research and technological developments will enable clinical application of the virtual and physical 3D models to enhance surgical vision before and during rectal cancer surgery.